Endo Battery

Endo Year Reflection: #16

• Alanna • Episode 105

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As we close out 2024 and our Endo Year Reflection series, this episode dives into one of the most important topics in endometriosis care—surgical mapping. Join me as I reflect on the insights from my conversation with Dr. Ramiro Cabrera in Episode 88, where we discuss why surgical mapping should be the gold standard in endometriosis treatment.

In this episode, we explore:

  • The value of surgical mapping in endometriosis care and why it should be prioritized
  • How imaging, when done correctly, can play a vital role in surgical planning and intervention
  • Dr. Cabrera’s perspective on how outdated U.S. protocols are when it comes to staging and imaging for endometriosis
  • My personal experience with surgeries and the impact of proper pre-surgical planning
  • The importance of ensuring your doctor has a clear, well-thought-out surgical plan before going under the knife
  • How understanding the need for realistic expectations and longer recovery times can improve your post-surgery journey

As we wrap up this year, I’m incredibly grateful for this community and the lessons we’ve shared together. Here’s to setting higher standards for endometriosis care in 2025!


Website endobattery.com

Speaker 1:

Welcome to EndoBattery, where I share my journey with endometriosis and chronic illness, while learning and growing along the way. This podcast is not a substitute for medical advice, but a supportive space to provide community and valuable information so you never have to face this journey alone. We embrace a range of perspectives that may not always align with our own. Believing that open dialogue helps us grow and gain new tools always align with our own. Believing that open dialogue helps us grow and gain new tools. Join me as I share stories of strength, resilience and hope, from personal experiences to expert insights. I'm your host, alana, and this is IndoBattery charging our lives when endometriosis drains us. Welcome back to IndoBattery. Grab your cup of coffee or your cup of tea and join me at the table for the last time this year. Happy New Year. As we close out this year and the Indo Year Reflection Series, I hope you're leaving this year feeling hopeful, inspired and full of anticipation for what's to come. This year has been a journey, hasn't it? Together, we've walked through challenges, breakthroughs and so many lessons. I've grown tremendously and found new confidence and guidance in my own journey, and I hope this podcast has done the same for you as we wrap up 2024,.

Speaker 1:

I feel it was only fitting to conclude this series with a discussion about a topic which should set the standard of care for the future, which is surgical mapping. In episode 88, I sat down with Dr Romero Cabrera to explore what should be the gold standard in presurgical intervention in endometriosis care. For the longest time, I believed what so many of us have been told Imaging is useless when it comes to endometriosis. And yes, there's a margin for error in diagnosing with imaging, especially when the person interpreting lacks the right training. But shifting my mindset to understand the value of imaging for surgical mapping, that was mind-blowing. What shocked me even more was learning just how outdated the US and other countries are in its protocol for staging and imaging for endometriosis. Take a listen to this insightful clip from Dr Ram as he breaks this down for us.

Speaker 2:

It's not something that I create. It's something that we replicate in Mexico and now it's being replicated worldwide. Mapping of the endometriosis started in Europe, in France and in Italy. They found out that the radiologists who are used to see the endometriosis with the special protocols because everyone in the US has an MRI every hospital has the best ultrasound. I can't even assure you they have the best ultrasound in the rest of the world. But the problem is that the radiologist needs to go through a learning curve to see deep endometriosis. By this we have to remember that endometriosis has to be subdivided in three types. Something is peritoneal disease or superficial. That is the one that is so little that even sometimes the human eye cannot see. Deep endometriosis is the one that infiltrates itself to other organs and that's the one who we can see through special imaging studies and ovarian endometrioma. That is the one that's super easy to diagnose With a normal office ultrasound. You can see the chocolate cyst and then we can suspect endometriosis. Now in Europe and France, in Italy, they started seeing that the radiologists to see this every day have better sensibility. That means that the eyes can see better the pedometriosis than the normal radiology population and they started to see that if they go before the study to do a rectal enema and when they perform a MRIs they put a rectal gel and vaginal gel and some medication for them for the bowel to not move, then they can see better the disease. You get me and with this, without going through surgery, they can diagnose if you have endometriosis, deep endometriosis in the bowel, in the bladder, diaphragm, so with this the surgeon can individualize the treatment and then get a special team of surgeons. If you have endometriosis in the diaphragm, then we need a cardiothoracic surgeon and so on. If you have endometriosis in the bladder, a urinary surgeon. If you have endometriosis in the colorectal area, we need a colorectal surgeon.

Speaker 2:

So in Italy and France they start doing something that is a high quality treatment. High quality treatment defines itself by doing a mapping of deep endometriosis. The mapping of deep endometriosis is a specialized imaging study in which an expert in radiology that has a super long learning curve at least five to 10 years with a specialized protocol. That means with bowel gel, rectal gel, bowel inhibitory movement medication, with an MRI or if they are going to do an ultrasound. It's not a normal ultrasound, I will say to you, it's an algorithm in which we have to see the african, we have to see the appendix, the sesum. We have to see the full bowel. That's an abdominal ultrasound with a bowel preparation. And then we go through the transvaginal ultrasound and see not only the uterus and ovaries Because, remember, by definition endometriosis is outside the uterus. So we have the bowel, the bladder, the ureters and with this a true expert in imaging can send us a classification, a presurgical classification that is mandatory worldwide. It's called the ANSI classification.

Speaker 2:

In the US they are still doing something that is Association for Reproductive, society of Medicine classification that divides the disease in stages, stage 1 to stage 4.

Speaker 2:

Right now that classification is really old.

Speaker 2:

It's the one that my father used to use, because if they go under surgery and they classify you with a stage four, like they did with my sister, my sister will tell you oh, thank you very much, but that doesn't mean anything. That means that I have in every place. With the NCM protocol we can do the classification before surgery. That's mandatory, and and with this we can see if the disease is affecting the intestine, the bladder or other organs, and not only see if it's affecting. We can also see the size of the nodule, the length, the percentage of bowel affection. So we, with this, we can plan the surgery before going in, because we'll never do again a laparoscopic diagnosis surgery without the mapping If they are going to do a laparoscopic surgery, the human eye cannot see through tissue. So if they enter and see everything attached to itself like a frozen pelvis, no surgeon, no surgeon worldwide, even the best surgeon in the world, even myself, if I go without a mapping, I cannot see the nodule because I can only see the superficial layers of the organs.

Speaker 1:

Hearing this and understanding why mapping matters is so important. As someone who's undergone multiple surgeries, including one where I expected a straightforward laparoscopy but woke up with a C-section length incision and a far more extensive procedure, I wish this approach had been available, or better known, back then. Dr Ram explains why this is so important. Take a listen.

Speaker 2:

So, as myself, there are many doctors who is trying to work for patients to get validated symptoms, to get you know, to see the disease before surgery and to do a planned surgery. So that's also really important. And something I think that you should also add to this podcast is that the surgery itself should always be done by true experts in excision. Yes, and I will always make it clear. Like my grandfather used to tell me, doing surgery is like playing the piano. You can take a 10-year lessons to play the piano, like I did. I used to take piano lessons, but I cannot create Mozart or Vivaldi. I cannot create. I can only play Coldplay. You get me, even if I'm 10 years, so that's an innate ability. Sometimes it's doing surgery.

Speaker 2:

You have to have, obviously, classes and like fellowships and everything, but not every surgeon would get into the point to get to full disease, because sometimes the disease affects the pelvic nerves, sometimes the disease affects the intestine, the bladder, the diaphragm, and if you don't have the skills to do it, even though you can stay 20 years in medical school and residency, some doctors, by shame will not get into the point. So that's why you have to get certified in surgery. You have to get validated that your surgery is a full, complete excision, you have to know how to not damage the organ that you're treating and leave function, because an oncologist all oncologists can take any organ away, like my father, but they always take it away but the function of the organ will be affected because it's cancer. And if I leave you with an ileostomy or colostomy or something that you cannot pee for your full life or cannot have orgasms, you will still say thank you, doctor, because I'm still alive. It was cancer in.

Speaker 2:

Endometriosis is totally different. Yes, endometriosis is not cancer. So if I do surgery like an oncologist and I cut the nerves, then you will not say thank you doctor. You will say, hey, I entered with pain and now I cannot poo, I cannot pee and I cannot have orgasms.

Speaker 2:

So, it was. Oh, thank you, doctor, you get me. Yeah, because it's not cancer. That's the difference between an oncologist who is one of the best surgeons worldwide and can take any organ away, and the endometriosis surgeon. We took parts of that organ, but will it function? That's something really important.

Speaker 1:

As we step into a new year, I hope we all set the bar higher for presurgical planning. For many of you, 2025 may bring surgery. Some of you may already have it on the schedule. My advice ensure your doctor has a clear, well-thought-out plan with solid reasoning behind it before agreeing to surgery. Trust me, this can make all the difference in your outcome and recovery. Having realistic expectations is equally important. Those with severe disease often need longer recovery times and additional strategies to achieve better quality of life, but knowing this beforehand can go a long way toward preparing you mentally, emotionally and physically.

Speaker 1:

Thank you for being part of this journey with me. It means the world that I get to do this and share it with you. I'm constantly looking for ways to improve this podcast and meet you where you are. If you have recommendations or questions, please email me at contactendobatterycom or message me on Instagram. I'd love to hear them. If this podcast has helped you this year, consider sharing it with others who might need a little endo recharge. Being part of this community is truly a gift. While this disease can take so much from us, it also gives us the strength and solidarity of walking along others who understand. Thank you for walking with me this year. I am abundantly grateful and until next year, continue advocating for you and for those that you love.